Payer executives are looking forward to investing in AI, improving equity and new care models in 2025.
The 18 executives featured in this article are speaking at the upcoming Becker's Payer Issues Roundtable. The fall roundtable will take place Nov. 4-6 at the Swissotel in Chicago.
If you have any questions about attending the event in November, contact Heidi Simon at hsimon@beckershealthcare.com.
Note: Responses have been lightly edited for length and clarity.
AI and technologies
Murali Kashaboina. Chief Data Officer at Health New England (Springfield, Mass.): The forthcoming investments in data, analytics, AI/gen-AI and predictive modeling hold immense potential. These technologies are transformative and are set to redefine how healthcare organizations foresee and manage health outcomes, personalize patient care and address fraud more effectively. True innovation will emerge from a member- and patient-first mindset. By uncovering nuanced patterns within members' and patients' data, the healthcare narrative can shift from illness to wellness. The industry stands at an inflection point to harness the power of machine learning and AI/gen-AI technologies, enabling the prediction of health risks before they arise, optimizing care pathways and offering individualized interventions leading to broader personalized health opportunities.
Doba Parushev. Managing Partner at Healthworx (Baltimore): Thematically, a lot of our work centers around the concept of eliminating healthcare waste: driving toward commensurate outcomes from what our members spend on care. I am excited to see the questions of fundamental value, clinical outcomes and impact on total cost of care once again take center stage as the market is going through a period of normalization after several years of frenetic activity. This makes me really look forward to the next cohort of startups that go back to these core principles of healthcare innovation, independent of the specific problem they tackle.
One of the most promising tools in this endeavor is currently AI, where there are two broad trends that we are carefully tracking. The first is an obvious and pragmatic one, focusing on the increasing ability to automate away some of the most laborious, repetitive and often frustrating tasks that exist across the healthcare ecosystem. Faced with an impending professional shortage and growing burnout in the industry, our ability to minimize the tedium and free up more time for the most productive and purpose-driven parts of people's work can have a large and long-lasting impact. The second trend is more aspirational, recognizing certain areas where AI tools are performing not only on-par with, but potentially better than humans. From being able to reliably draw on much larger knowledge bases, to communicating in a consistent, highly empathetic manner, I expect to see a number of applications in the next year where AI tools push the limits of what we have been able to historically achieve
Shelley Turk. Divisional Senior Vice President of Illinois Health Care Delivery at Health Care Service Corp. (Chicago): I am excited about our innovation with analytics! Our members entrust us to advocate on their behalf, and Blue Cross and Blue Shield of Illinois offers a variety of network solutions. At the heart of that market innovation has been analysis, and we are continually improving that capability. In 2025, we will make deeper, targeted investments in our foundational and enhanced analysis capabilities, supporting our engagement with providers.
I am particularly excited about partnering with providers to launch an obesity, value-based, care offering, with data science-generated insights as one part of provider enablement. I am also cautiously optimistic about the potential we are seeing in early testing of controlled, generative AI tools that can deliver value by reducing processing time. To guide all of this innovation, our company developed a responsible AI governance framework and I am proud of the Illinois healthcare delivery team’s application of that guidance during a transformative era for AI. Most importantly, I am excited about my strong team here at BCBSIL in healthcare delivery and their dedication to serving our members and communities.
Ty Wang. Co-Founder and CEO of Angle Health. (San Francisco): We are most excited about our investments in AI capabilities and value-based care partnerships with key clinical point solutions. We built Angle Health from the ground up on a unified data infrastructure that enables us to take full advantage of the innovations in AI and machine-learning to drive workflows across all our health plan operations. The pace of technological advancement in this age of AI will continue to unlock operational efficiencies, increase engagement rates, and improve the quality and accessibility of care at an unprecedented rate. We believe that the next generation of payers and health plans will be built on cutting-edge technology powering operations and member engagement paired with the best-in-class solutions across disease management, pharmacy, and the rest of the care continuum, and those unable to adopt these technologies will see their market share fall rapidly in the coming years.
Troy Williams. Vice President, Hospital Partnerships at First Choice Health Network (Seattle): We continue to automate many of our credentialing, provider relations and customer service interactions and those upgrades have included expanding our AWS, and Salesforce platform interactions. These investments give us more options to interact with clients, generate useful reporting and to analyze our business and growth patterns in new ways. With some of these investments, we have already begun to hire additional personnel. Welcoming those expansion team members and bringing them on board with savvy tools is exciting.
Health outcomes and equity
Abdou Bah. Senior Vice President, Medical Management and Chief Health Equity Officer at EmblemHealth (New York City): We are excited about investments we are making to improve the health of our community by increasing access to health care services. A few examples include investments in digital clinical solutions to assist our members in areas where there is a shortage of providers, investments in behavioral health solutions to address growing needs, and artificial intelligence to help our members better navigate the complexities of the healthcare system. EmblemHealth is also investing even more in chronic condition support and our Neighborhood Care centers, where we provide in-person resources to everyone who walks through our doors.
John Cordier. CEO of Epistemix (Pittsburgh):
- Enabling health equity decision makers to ask "what if" questions with detailed models by investing in large language models to increase accessibility and trust.
- Building the largest library of public health impact studies that can be scaled and tailored to local contexts.
- Advancing our digital twin of the United States to include incidence and prevalence of chronic conditions.
- Increasing access to products and services that enable short-term revenue objectives to align with long-term risk reduction for payers.
Dennis Hillen. Senior Vice President, Market Leadership at Oscar Health (New York City): Oscar continues to invest to make the ACA marketplace the chosen solution for more Americans. As we expand our footprint to new markets, we are able to bring more, affordable and tech-savvy solutions to our growing, diverse membership base. In 2025, we are launching new solutions, including Buena Salud, a new Spanish-first program and guided care HMO that delivers a highly connected experience without the pain points of traditional HMOs. These products showcase how we are meeting the unique health needs of our members.
Ray Prushnok. Assistant Vice President, Program Development and Social Impact at UPMC Health Plan (Pittsburgh): As more states are on track to add health-related social needs services to Medicaid managed care programs in the coming years, I'm excited by these novel opportunities to address barriers to health and go upstream in supporting member needs. For example, at UPMC Health Plan, we have operated a supportive housing program that serves members experiencing homelessness for over a decade, housing 240 members with over 75% of these members housed since 2019. This program braids subsidized housing with healthcare supportive services and funds community-based organizations working with members to address ongoing needs, including landlord-tenant relations and readying members to enter the housing system. We have seen positive clinical and financial results from our investment and are planning expansion into a fourth county this fall. As Pennsylvania proposes to provide rent support, we are excited to accelerate this work and adopt a robust housing-first approach.
Jennifer St. Thomas. Senior Vice President, Commercial and Medicare Markets at Mass General Brigham Health Plan (Sommerville, Mass.): I am most excited to see that there is more awareness and support for expanding access to mental healthcare. In particular, we are hearing from our members and the marketplace about the need for mental health services for teens experiencing anxiety and depression, as well as more comprehensive options for employers. In response to demand, Mass General Brigham Health Plan continues to make investments to expand access to innovative, tailored mental health solutions that meet members where they are in their healthcare journeys.
Jeremy Wigginton, MD. Chief Medical Officer at Capital Blue Cross (Harrisburg, Pa.): I am most excited about furthering investments in whole-person care. This includes investments in people, processes and technology to further integrate our members’ behavioral, emotional, and social needs into our clinical programs. By approaching our members' needs holistically, we can provide more impactful and personalized support. By Jan. 1, 2025, we will have a completely in-sourced and integrated model of care that will cross all plan functions including customer service, utilization management, care management, and provider partnerships. These investments will help our members lead healthier lives with access to more resources and a stronger relationship with their care team across the healthcare ecosystem.
ICHRA
Jack Hooper. CEO and Co-Founder of Take Command Health (Richardson, Texas): This year, we are excited to continue investing in ICHRA infrastructure to build the ICHRA market. We are seeing the positive impact of ICHRA with employees getting to control their healthcare spend. We are excited to collaborate with payers that are eager to win with ICHRA as well.
We continue to automate many of our credentialing, provider relations and customer service interactions and those upgrades have included expanding our AWS, and Salesforce platform interactions. These investments give us more options to interact with clients, generate useful reporting and to analyze our business and growth patterns in new ways. With some of these investments, we have already begun to hire additional personnel. Welcoming those expansion team members and bringing them on board with savvy tools is exciting.
Alessa Quane. Chief Insurance Officer of Oscar Health (New York City): In 2025, our investments will help bring affordable healthcare to more small and medium-sized business owners and their employees through ICHRA. These businesses are the backbone of our economy and continue to struggle with double-digit increases in traditional small group plans or simply cannot afford to offer their employees health coverage. Oscar's efforts to bring the ACA marketplace to these employers and employees is game-changing. Employers can offer employees a pretax contribution that employees can use to buy individual health insurance. It’s a win-win for employers and employees.
Value-based care
Ananya Banerjee. Chief Commercial Officer at Aledade (Bethesda, Md.): I am excited about the investment Aledade has made in developing strong partnerships with more than 25 health plans, enabling us to connect even more of our 1,900-plus primary care practice partners to value-based care arrangements.
For example, in Virginia, Aledade is collaborating with Anthem to give more than 150,000 Anthem members easier access to high-quality primary care, including preventive care and screenings. This partnership supports more than 80 primary care practices, 15 health centers and 25 rural health clinics across Virginia and covers Medicare Advantage, commercially insured and Medicaid members.
Our long-term relationships with health plans and primary care practices drive alignment across the health care system, which results in healthier patients, fewer expensive and unnecessary procedures and enhanced revenue for practices.
Sean Cavanaugh. Chief Policy Officer at Aledade. (Bethesda, Md.) I'm excited about the new primary care ACO flex model, which builds on a decade of learning from the Medicare shared savings pProgram and early primary care models tested by the CMS innovation center.
MSSP is the permanent, flagship accountable care organization program that has generated more than $1.8 billion in savings since its inception while improving the quality of care received by Medicare beneficiaries. One of the longstanding challenges to the ACO model has been the delay between the time when providers improve care for Medicare beneficiaries and when they receive shared savings payments for this work, which is typically late in the following year.
Flex will test whether providing ACOs with an advance on shared savings and paying for primary care within ACOs based on an enhanced, prospective payment, in lieu of traditional fee-for-service payments, will enhance participation in ACOs.
Flex also will test whether these ACOs have the ability to generate additional cost savings and care improvements for Medicare beneficiaries. We commend CMS for introducing the Flex model to further incentivize participation in accountable care models. We applaud CMS for introducing the Flex model to help our partner primary care practices.
Chris Wasel. President, Marketing & Strategic Partnerships at Vantage Healthcare (Canton, Mass.): 2025 will be a very busy year for Vantage Healthcare. Our primary new investments in resources and systems will be tied to the value-based payment models that we plan to participate in. First, starting in January we will expand our MSSP ACO participation beyond skilled nursing into assisted living. Soon after, through a strategic partnership we will start our guiding an improved dementia experience model in assisted living. Finally, during the course of the year we will partner with hospital health systems to assist with their rollout and management of episodes under the newly announced transforming episode accountability model. We are excited about these opportunities in the coming year and our investment in these important initiatives.
Workforce
Karen Schulte. President, Medicare at SCAN Health Plan (Long Beach, Calif.): At SCAN we are thrilled to welcome Bob Chapek as a senior advisor. His renowned experience and expertise in creating exceptional customer experiences during his time at Disney will be instrumental in creating a member-obsessed culture at SCAN and delivering memorable member experiences.
Krischa Winright. President, Medicare Advantage at Blue Cross Blue Shield of Michigan (Detroit): There are two critical areas where successful organizations will need to invest; their workforce and the technology used to support them. With the national workforce continuing to decline in numbers and companies being asked to continue to do more with less, investing in our people is a priority. In fact, the U.S. Chamber of Commerce recently shared the latest data showing we have 8 million job openings in the U.S. but only 6.8 million unemployed workers. Those numbers are expected to continue to diverge as the population ages. We need to help our current talent skill-up, take advantage of added efficiencies and adapt as roles will need to expand.
A key resource to support teams in their work is smarter technology. To help teams move quickly, support decision-making and drive optimized performance, we need to make serious investments in technology, artificial intelligence and become better equipped to leverage the data available within our systems. In fact, according to the National Library of Medicine, it's estimated that AI applications can cut annual U.S. healthcare costs by $150 billion. A large part of these cost reductions centers on efficiencies — across health care operations and how we fundamentally support patients and provider partners. If we can get this right within the healthcare industry, we will be able to ensure patients can continue to have access to excellent and affordable health care into the future.